Monday, December 17, 2012

It's a Mad, Mad, Mad, Mad ObamaCare

The law's implementation is turning into one pratfall after
another.

For sheer political farce, not much can compete with ObamaCare's passage,
which included slipping the bill through the Senate before dawn three Christmas
eves ago. But the madcap dash to get ready for the entitlement's October 2013
start-up date is a pretty close second.

The size and complexity of the Affordable Care Act meant that its
implementation was never going to easy. But behind the scenes, even states that
support or might support the Affordable Care Act are frustrated about the Health
and Human Services Department's special combination of rigidity and
ineptitude.
To take one example, for the better part of a year states and groups like the
bipartisan National Governors Association and the National Association of
Medicaid Directors have been begging HHS merely for information about how
they're required to make ObamaCare work in practice. There was radio silence
from Washington, with time running out. Louisiana and other states even took to
filing Freedom of Information Act requests, which are still pending.

Getty Images

Secretary of Health and Human Services Kathleen
Sebelius

Now post-election, new regulations are pouring out from HHS—more than 13,000
pages so far and yet nuts-and-bolts questions are still unanswered. Most of what
we know so far comes from a 17-page question-and-answer document that HHS
divulged this week, though none of the answers have the force of law and HHS
says they're subject to change at any moment.
HHS is generally issuing rules with only 30 days for public comment when the
standard is 60 days and for complex regulations 90 days and more. But the larger
problem is that HHS's Federal Register filings reveal many of the rules were
approved in-house and ready to go as early as May. Why the delay?
To take another example, the feds are building a data hub to determine who is
eligible for Medicaid and ObamaCare's "exchanges," the bureaucracies that will
dispense insurance subsidies and police the market. Many states have cut
administrative costs by combining the application process for Medicaid, food
stamps, cash assistance and other antipoverty programs, but HHS's privacy rules
say the hub can only be used for ObamaCare. So HHS will force states to become
less efficient and flatly refuses to reconsider.
In a word, HHS is treating the states not as the partners it needs to give
ObamaCare any chance of success, but as serfs.
HHS did finally if "conditionally" approve the exchange blueprints of six
states this week, though it has yet to release any formal objective standards
for conditional approval. Some 24 states are refusing to participate, so the
agency will be running a federal fallback exchange that it won't reveal how it
will operate.
A federal exchange is a vast undertaking. The clearinghouses will be open to
the uninsured but also to small businesses and people who already buy plans on
the individual market. On average about a quarter of a state's population are
expected to at least browse the exchange options, and the share will be far
higher in states with large numbers of uninsured people under 65, like New
Mexico (24%), Georgia (22%) and Texas (27%).
If 20% of Americans use exchanges, that's 62 million people. At a House
Energy and Commerce hearing on Thursday, ObamaCare point man Gary Cohen all but
took the Fifth on how he'll deal with this and other challenges.
The exchange naysayers now notably include Chris Christie of
New Jersey and Bill Haslam of Tennessee. Sure, they're Republicans, but both
Governors flirted with the idea and wanted to participate if it would result in
a saner and more rational marketplace. The costs and risks were too high.
HHS also declared this week that states can decide either to expand Medicaid
(after the Supreme Court decision made it optional), or not. But states are not
allowed to make the partial expansion that many states would have considered.
This all-or-nothing political gambit is meant to put the Governors in a bad
political spot at home if they don't expand, but the irony is that many of them
would participate if HHS gave them more flexibility to manage their own programs
and control costs.
Yet HHS has made it almost impossible to qualify for Medicaid waivers. States
aren't even allowed to "go green" by using digital instead of paper
applications. These "maintenance of effort" rules weren't carved in stone
tablets by LBJ. HHS formalized them in a regulation this February.

***

In other implementation hilarity, no fewer than 18 Democratic Senators and
Senators-elect came out last week against ObamaCare's $28 billion tax on medical
device sales—and not just the usual penitents from Massachusetts and Minnesota.
The list includes Chuck Schumer, Dick Durbin and Patty Murray.
"With this year quickly drawing to a close, the medical device industry has
receive little guidance about how to comply with the tax—causing significant
uncertainty and confusion for businesses," they write about the tax most of them
voted for.
The last entitlement to get off the ground was President Bush's Medicare
prescription drug benefit. Those rules were tied up with a bow by January 2005,
giving business and government nearly a year to prepare—and that was far simpler
than re-engineering 17% of the economy. No one knows where the current magical
mystery tour is headed, especially not HHS.

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About Me

pole'cat n. 1. creature of fierce, brave, fearless heart willing to go against opponents at a moments notice. 2. nickname of one Don Polson in grade school in Heyworth, Illinois, frequently used in a game of "red rover," as in "red rover, red rover, let polecat come over" upon which said polecat flung himself into the opposing line with abandon.
I'm happy to provide you with some of the best conservative stuff (and non-conservative stuff that, nonetheless, helps inform and illumine) I can find on the web. Oldest posts are at the end--enjoy and learn something.